|
|
|
Project Experiences
|
|
|
|
3M HCSC has used Lean Six Sigma methodology to help hospitals reach hand hygiene
compliance targets. This was achieved through team-driven, 3M HCSC led data collection,
baseline data analysis and development of an unbiased hand hygiene compliance auditing
method to build the case for change. Facilitation by 3M HCSC led the team through
team building exercises, baseline data collection, process mapping, and team-based
tools to isolate major opportunities for improvement and develop an Improvement
Strategy in the pilot unit, and an implementation strategy to roll out to the entire
facility.
|
Hand Hygiene Compliance is a known and current issue on the minds of both health
care organizations and the public. Despite having policies and procedures in place,
many health care organizations still struggle with developing and maintaining minimum
compliance levels.
|
|
|
|
3M HCSC offers a proven method for process improvement and its application to emergency
departments in health care organizations has led to an increase in patient and ED
staff satisfaction, as well as reductions in patient lengths of stay.
Working with a team, 3M HCSC performed data collection as needed, followed by a
statistical analysis using Lean Six Sigma methodology to build a case for change.
Hand in hand, data analysis and value stream mapping allowed the team to identify
waste, broken links in the process, and areas for improvement. Once target areas
were identified, 3M HCSC helped to focus the team’s activities to implement recommendations
and improve patient flow.
|
As the “front door” of the hospital, the Emergency Department (ED) is the first
encounter many patients have with the hospital. A patient’s perceptions, positive
or negative, of the rest of the hospital may be formed during this initial encounter.
Unfortunately, a trend toward longer wait times, even for critically ill patients,
has brought emergency rooms to the breaking point in many health care organizations.
Understaffing is often touted as the major issue but experience has shown that process
improvement has been able to alleviate some of the major wait time issues
|
|
|
|
Using Lean tools, 3M HCSC has helped hospitals understand and address the barriers
to effective movement of patients and materials. For both dedicated and centralized
portering services, use of process mapping, process observation and data capture,
and team tools helped all parties understand the obstacles that needed to be overcome
to achieve effective portering service utilization. By helping to develop a long-term
vision, engaging stakeholders from affected departments throughout the organization,
and identifying solutions that can be implemented, hospitals achieved greater efficiency
in the use of portering services.
|
Movement of patients and materials throughout the hospital is often a challenge.
When communication between various hospital departments and Patient Transport or
Portering resources is fragmented, it can be frustrating for everyone involved.
Critical and expensive processes, such as diagnostic imaging and the emergency department,
can be congested or deprived when portering resources are not available or delayed.
Effective use of this key human resource is a major concern for many health care
organizations.
|
|
|
|
Using Lean Six Sigma, 3M HCSC has enabled hospitals to reduce the length of time
patients wait in the ED after admission. 3M HCSC helped to engage diverse groups
to resolve a shared problem Stakeholders from the Emergency Department, as well
as medical units on the floor used team tools to collect data and map the process
in order to better understand it.. After brainstorming options, and piloting solutions,
the team successfully reduced the time patients spend waiting to move from the ED
to the floor.
|
Many Emergency Departments are feeling the pressure of admitted patients who have
not moved to the floor because of congestion within the hospital. Because these
patients require a different level of care and monitoring, they put additional strain
on ED staff and negatively impact the efficiency of the ED to manage the flow of
new patients.
Under serious pressure, some hospitals have considered strategies to move these
patients to the floor to wait in halls until a room is available. But the trade
off to gain efficiency in the ED creates the potential for risk on the floor.
|
|
|
|
3M's HCSC has used Six Sigma methodologies successfully in the OR Suite to help
identify the major factors contributing to SSIs. Six Sigma tools were applied within
a simple performance-improvement framework known as DMAIC (Define-Measure-Analyse-Improve-Control),
which allowed the team toward to identify tangible project deliverables as well
as valid and reliable metrics. The team also developed methods to measure success,
to control risk, quality, cost, to manage unanticipated plan changes, and to maintain
the gains achieved. Engaged teams used hospital data and observational assessment
to understand the perioperative process at a deeper level and reduce infection rates
in total hip and knee replacement surgeries.
|
Surgical Site Infections (SSIs) are a facility-wide issue with a tremendous impact
as 77% of deaths in surgical patients with nosocomial infections can be traced to
an SSI1.
SSIs can also lead to repeat surgeries, prolonged immobilization, and delayed recovery;
which are overwhelming for patients and families.
Length of stay (LOS) and waiting lists are significantly impacted as SSIs add between
11 and 27.9 days2 to a surgical patient’s LOS. This extended LOS along
with the need for repeat surgeries contributes to waiting list issues.
Based on conservative estimates, the average Canadian hospital spends between $1.2MM
- $12.6MM (depending on surgical volumes) each year managing SSIs3
1 - “Total and attributable costs of surgical wound infections at a Canadian tertiary
– care center”, Dick Zoutman et al, Infection Control and Hospital Epidemiology,
Vol. 19, No. 4, April 1998: 254 - 259
2 - “ The effect of surgical wound infection on postoperative hospital stay”, Geoffrey
D. Taylor et al, Canadian Journal of Surgery, Vol. 38, No. 2, April 1995: 149 –
153
3 – “Surgical site infections: An obvious target for quality improvement and patient
safety initiatives”, Dr. Anne Matlow and Dr. Dick Zoutman, The Canadian Journal
of Infection Control, Vol. 19, No. 4, Winter 2004: 208 - 209
|
|
|
|
Medication reconciliation, a process that compares a patient’s current list of medications
against the physician’s admission, transfer, and/or discharge orders, must be done
in a standardized manner to ensure complete reconciliation, and avoid medication
errors.
Addressing these concerns required a diverse cross-functional team working toward
the common goal of reducing missed medications and medication errors to improve
patient safety. To build the case for change, 3M HCSC used Lean Six Sigma methodology
to perform thorough data collection and root cause error analysis in the medication
administration process. Working with the team, 3M HCSC facilitated the development
of an improvement plan, and prioritization matrix of improvement ideas generated
by the team, to create a manageable and sustainable medication administration process.
|
According to the Institute for Healthcare Improvement, up to 50% of all medication
errors in the hospital, and up to 20% of adverse drug events are the result of poor
communication of medical information at transition points.
Too often, medication is not transferred with the patient and is not available on
the receiving floor when needed. Physician orders may not reach the pharmacy in
the time required, or dispensing machines may allot incorrect dosages.
Failures, such as missed doses, in this process of communicating, dispensing and
delivering patient specific medication at the hospital unit level can start a chain
of events leading to a host of safety concerns.
|
|
|
|
Understanding where an operation is in its current state is an integral part of
any process improvement initiative. In order to establish the flow of information,
products, or people in any process, it is necessary to review the available process
data and tap the knowledge of the staff engaged in the operation being reviewed.
By understanding the present state, teams can build a vision of the future more
effectively.
3M HCSC has the expertise to help identify necessary data, and draw upon the collective
wisdom of the team to fully understand the current state. By using the appropriate
tools, we help teams identify current gaps and opportunities, create a vision for
their future state, and develop action planning to get there.
|
|
|
|
|
| |
|
|
